The Man Who MistookOliver Sacks is a neuropsychologist and writer famous for his case history approach to neuropsychology and his interest in the relationship between mental disorder and personality. He first gained notice following the publication of his book Awakenings, about sufferers of the 1920s sleeping sickness who suddenly woke decades later.

The Man Who Mistook His Wife for a Hat is a series of episodic case studies of neurological disorders. Sacks presents his cases as if they are tales or fables but often real life doesn’t end as neatly or artistically as stories. Sometimes he never sees the patient again or never finds out what caused their condition. In the titular case Sacks encounters the patient only once and can do nothing for him. Sacks approach is that of a type of neuropsychologist/philosopher. The neuropsychologist A. R. Luria’s concept of ‘Romantic science’ – gaining insight into human life from looking at extended case histories – heavily influenced Sacks’ work.

The case studies are separated into sections – ‘Losses’, ‘Excesses’, ‘Transports’, and ‘The World of the Simple’ – each a loose categorisation of the way Sacks’ patients’ neurological disorders manifest themselves. ‘Losses’ (when a patient loses brain function) includes face blindness and amnesia. ‘Excesses’ (a superabundance of function) includes loss of inhibition brought on by neurosyphilis and Tourette’s syndrome. ‘Transports’ details various hallucinations caused by migraines and seizures. ‘The World of the Simple’ deals with mentally disabled patients, in particular Sacks’ experience using music, art and theatre to bring out their unique talents.

‘Losses’ or ‘deficits’ are a huge part of neuropsychology but I found that section to be the least interesting. It wasn’t until I got to the section on ‘Excesses’ that I was really engaged. Sacks explains that neurology has no technical word for what he describes as ‘excesses’ since neurology is only concerned with mechanical function – is the brain functioning normally or is it faulty? The idea of excessive function complicates this duality, it forces neurologists to think beyond the brain-as-computer and be concerned with the ‘life of the mind’. Sacks’ real interest lies in the interaction between the person and the disease, so it’s not surprising that once he moves past the standard cases of loss (phantom limbs and amnesia) The Man Who Mistook His Wife for a Hat becomes less restrained, and more searching, letting Sacks’ natural curiosity about people shine through.

One of the key questions brought up by exploring the relationship between the self and the disease is, does identity survive the disorder intact? Does the disease become identity? ‘Witty Ticcy Ray’ is a sufferer of Tourette’s syndrome, prone to uncontrollable tics and outbursts. But his Tourette’s also gave him abnormally quick reflexes and an ebullient, unpredictable personality, making him an excellent jazz drummer. When treated with haldol Ray lost his sense of timing and exuberance, taking away something that was part of his identity. Ray had to find out who he is without Tourette’s and whether it’s someone he wants to be.

The other side of the question of personality surviving disorder is when a patient suddenly develops a neurological deficit. Sacks writes about the soul, about patients possibly ‘de-souled’ by disease, ‘damned’ or ‘possessed’. Gladly, he’s not really questioning the presence of a soul in the theological context. Given that I’m not religious, I think the concept of eternal damnation is dubious enough, let alone the idea of being damned for a disorder that is beyond control. He means it as an existential question – the ‘soul’ as signifier of humanity – which still made me a bit uncomfortable. As if, without this elusive ‘soul’ a person isn’t really a person. Sacks’ use of the language of religion –‘soul’, ‘possessed’, ‘damnation’, ‘God-forsaken’ – did nothing to make me more comfortable with the idea.

In ‘Transports’ Sacks details a case of aural hallucinations brought on by epilepsy – hallucinatory seizures take the form of music, often the same tune is heard again and again by the patient. Sacks explores why certain songs are selected by the brain during ‘musical epilepsy’. As far as anyone knows the song selection is quite random but Sacks believes that deeper analysis might reveal a hidden importance. As far as neuropsychology goes it’s probably unnecessary to know why a patient hears a particular song, that they hear it should suffice. Sacks’ curiosity ranges beyond his direct field, he’s curious about people and what makes them uniquely them.

The Man Who Mistook His Wife for a Hat is perfect for dipping in and out of because it’s broken into short case histories, but it’s less compelling as a result. It’s a slim book but it’s quite dense, with Sacks’ writing style tending to be overly involved. Despite the disconnected structure The Man Who Mistook His Wife for a Hat is best read from start to finish because Sacks references other case studies in the book, creating links between them and reminding readers of what has gone before. He often mentions his previous book Awakenings, those patients’ stories are often linked to the cases at hand. If you’re unfamiliar with the case that Awakenings deals with then Sacks’ references sometimes seem incomplete. Luria’s work (especially his ‘Man with a Shattered World’ and ‘Mnemonist’) is also discussed but never explained as fully as I’d have liked.

Sacks’ anecdotal approach to clinical research has been the subject of occasional criticism. The cases in The Man Who Mistook His Wife for a Hat do come across as strange stories about people who happen to have neurological disorders rather than scientific studies. But Sacks seems to be a neuropsychologist more attuned to the literary world than the scientific.

While his patients’ stories are told with compassion and concern, there is a risk it could come across as exploitative – a modern freak show read for thrills? I didn’t read it that way though. Occasionally his concern can come across as a bit condescending or moralising but Sacks doesn’t emphasise the shock value. I came away with the impression that while these cases might at first seem bizarre, in the realm of neuropsychology these disorders are an everyday reality.

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